Urinay tract infection from the community in pediatric patients of the Clinica Universitaria Bolivariana. Etiology, clinical presentation, risk factors and clinical response to initial empirical therapy
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Abstract
Objective: to describe the clinical characteristics, identify possible risk factors (RF) for UTI, describe antibiotic sensitivity profiles, evaluate the institutional empirical antibiotic protocol and the clinical response to initial empirical therapy.
Methods: cross-sectional observational study from february/2009 to january /2010.
Results: 47 patients were admitted, 25 males (53,2%) and 22 females (46,8%). The most frequent age group in both sexes was 1-24 months (76,5%), predominating in the male gender (58,3%). RF were found in 51,1% of the patients and 21,2% showed two or more RF. The main ones being: previous UTI (19.1%), urinary tract malformations (17%), constipation (12,7%), bad higiene (12.7%), vesicoureteral reflux (6,4%). The main aetiological agents isolated were: Escherichia coli (31), Proteus mirabilis (5), Klebsiella pneumoniae (3) and Citrobacter freudii (2); 2 and 5 isolates had extended spectrum beta-lactamases (βLEE) and AMP C β-lactamases, respectively. Resolution of fever occurred in the first 36 hours in the majority of the patients (87%), independent of resistance profile of the isolates. This being a reliable parameter of clinical response to empirical anitbiotic therapy with aminoglycosides.
Conclusions: febrile UTI was the main clinical presentation with a high percentage of RF identified only by history and physical examination. βLEE+ or AmpC+ bacteria were isolated from the community. At an institutional level the use of aminoglycosides are a good alternative for the initial treatment due to the good clinical response and low level of resistance.
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